December 17, 2017

Priority Issue: Diabetes Student Health Services

 

Diabetes Student Health Services Bill Passes with MABE Support

Legislation passed in 2016, with amendments supported by MABE, to require the Maryland State Department of Education (MSDE) and the Department of Health and Mental Hygiene (DHMH), to establish guidelines for public schools regarding the administration of health care services to students with diabetes and provide specified technical assistance to schools to implement the guidelines (HB 771, "Public Schools – Administration of Diabetes Care Services – Guidelines").

MSDE and DHMH, in consultation with the other specified and interested stakeholders, must establish a plan for all public school health services programs in the State to provide diabetes care services so that students with diabetes can (1) remain safe in school; (2) be supported for optimal academic achievement; and (3) fully participate in all aspects of school programing, including after-school activities and other school-sponsored events. By December 1, 2016, MSDE and DHMH must report to specified committees on the implementation of the plan. The bill takes effect July 1, 2016. (Delegate D. Barnes)  

MABE opposed this legislation as introduced, which would have required school system to recruit and train non-medical staff to administer oral and injectable diabetes medication. MABE supports the compromise legislation which preserves the oversight responsibilities of school nurses under updated state guidelines. The guidelines developed by DHMH and MSDE must include, as specified in the bill:

  • Procedures for treating and administering medication to control diabetic symptoms; 
  • Procedures for monitoring blood glucose and ketone levels; 
  • A description of parental or caregiver responsibilities in relation to the care of their child with diabetes, which must include specified elements; 
  • A description of school responsibilities in relation to the care of a student with diabetes, which must include specified elements; 
  • A description of student responsibilities in relation to the student’s diabetes care that are age and clinically appropriate; 
  • Procedures for students who have been determined by the school nurse to be capable of and responsible for self-management of their diabetes in accordance with heath care provider orders; and 
  • Any other issue that is relevant to the administration of health care services to students with diabetes. 

MSDE and DHMH must provide technical assistance to schools to: 

  • Implement the guidelines established under the bill; 
  • Instruct school personnel at the local level regarding the guidelines established under the bill; and 
  • Develop a process to monitor the implementation of the guidelines established under the bill. 

An individual who has received instruction to provide diabetes care services to students in accordance with the guidelines adopted under the bill is not civilly liable for any act or omission in the course of providing diabetes care services to a student if: 

  • The individual is acting in good faith while providing diabetes care services to a student who is in need of diabetes care services or to a student who the individual believes in good faith to be in need of diabetes care services; 
  • The diabetes care services are provided in a reasonably prudent manner; and 
  • The diabetes care services are provided to the student without fee or other compensation.

Work has been ongoing to revise the state school health guidelines throughout the 2016 interim in preparation for the 2016-2017 school year. 

For more information, contact John R. Woolums, Esq., MABE's Director of Governmental Relations, at jwoolums@mabe.org or 410-841-5414.


Background

During the 2015 and 2016 legislative sessions, MABE strongly opposed legislation which would impose a substantial unfunded mandate on local school systems to train and employ additional staff to provide medical services to students with diabetes. This legislation would have created a new school health services program to require school system employees to provide diabetes care to students during the school day and while attending school-sponsored activities. Student diabetes management programs would be required in each school, and the bill intends for the health care to be provided by trained volunteers. MABE, and the local boards we represent, are deeply concerned with the scope of the fiscal impact and liabilities arising from these proposals.

The diabetes management program proposed by Senate Bill 672 would require schools to:

  • Recruit employees who are interested in becoming trained diabetes care providers; 
  • Provide training for employee volunteers before the commencement of a school year or when required by the enrollment of a student with a Diabetes Medical Management Plan; 
  • Designate locations within the school where a student may privately perform diabetes care tasks; 
  • Require the school nurse or a trained diabetes care provider to be on-site and available to provide diabetes care services during school hours and at school-sponsored activities, including field trips; 
  • Establish a system of communication between school administrators and the faculty, school nurse, trained diabetes care providers, parents or guardians of students, and students; 
  • Facilitate the access of authorized school personnel to student Diabetes Medical Management Plans; and 
  • Establish procedures for diabetes-related emergencies.

School system health professionals raised serious objections to these requirements. Major areas of concern include the immense and ongoing responsibilities for recruiting volunteers; maintaining the level of skills, training, practice and supervision required to ensure the competency of these volunteers; the complex factors that impact diabetes management; and insulin pump technology. To be clear, school health professionals are currently providing appropriate care for students with diabetes during the school day. However, these medical services are provided to the individual student by a trained school health team, and are based upon the student's self-management abilities. Local school systems do not believe the breadth and scope of the mandates included in this legislation would advance the school system commitment to providing the appropriate level of services to students with diabetes, on a case-by-case basis, and in accordance with school health services and professional nursing standards.  

On November 21, 2015, the Departments of Health and Mental Hygiene and Education, in conjunction with the Children's National Health System, held a stakeholders meeting on "Diabetes Management in Schools." very informative presentations were made by Dr. Fran Cogen with Children's National Health System; Shirley Devaris with the Maryland Board of Nursing; and Nancy Mattucci and Mary Nasuta with the Maryland Association of School Health Nurses.